The Brazilian public health system has less inequality than the educational system

Evidence was presented by researchers at the Centro de Estudos da Metrópole using a new methodology developed to evaluate the performance of social policy on education and health.

By Elton Alisson

Agência FAPESP – The basic health service system in Brazilian municipalities has much less inequality than the country’s public education system. Evidence comes from a study conducted at the Centro de Estudos da Metrópole (CEM), a FAPESP Research, Innovation and Dissemination Center (CEPID) and a National Science and Technology Institute (INCT).

Over the last three years, researchers at CEM analyzed the performance of public education and health policies in Brazil during the 2000s using a new methodology they developed, called the Health and Education Performance Index.

The researchers say that this methodology, a matrix composed of ten social and health policy performance indicators evaluated on a scale from 0 to 1, is more reliable and allows for better evaluation of education and health policies in Brazil than do indicators such as the Human Development Index (HDI) by the United Nations Development Programme (UNDP).

Utilized on a broad scale to measure the level of economic development and quality of life of a country’s population in comparison with others, the CEM researchers claim that the HDI does not allow for adequate evaluation of decentralized public service systems such as those in Brazil, where states and municipalities are responsible for providing education, health and other basic services to the population.

“The HDI measures factors outside the reach of Brazilian municipalities and states, like illiteracy rates and income. Because of this, we developed a methodology that we believe is more trustworthy and that allows us to evaluate the performance of social health and education policies under the jurisdiction of mayors or governors so they can effectively bring about change,” said Marta Arretche, CEM director and professor in the Political Sciences Department at Universidade de São Paulo (USP).

In applying the new methodology to evaluate the performance of health policy in the country from 2004-2006 and 2007-2009, the researchers found no significant inequalities in the basic Brazilian health system. For example, they did not find municipalities with excellent services and others with very poor public health services.

According to the researchers, however, this does not mean that there were no regressions in health services in Brazil in the 2000s. Comparing the 2007-2009 period to the 2004-2006 period, a significant number of municipalities showed a slight worsening of basic health services systems. The researchers say that this phenomenon is mostly related to the increased incidence of dengue.

“Some 25% of all municipalities were unable to control dengue in the 2007-2009 period, whereas from 2004-2006, only 5% were in this situation,” said Arretche.

In terms of education, there is evidence of improvement in many indicators accompanied by increased inequality in the Brazilian municipal system, characterized by “islands of excellence” in which only a few cities in the nation’s richest regions have good systems, surrounded by a sea of poor performance.

Comparing the scores obtained by the municipalities in 2003-2005 and 2007-2009 in the Prova Brasil, created by the Ministry of Education (MEC) to evaluate the country’s basic education system, the CEM researchers found that, on average, municipalities’ performance improved in this area. Overall, the distance between the group with the best performance and the group that is improving more slowly is increasing.

“There is a set of municipalities in the Brazilian municipal and state educational system whose performance is better than the rest. The inequality between Brazilian municipal schools is increasing,” said Arretche.

Some of the factors responsible for the changing performance in the Brazilian municipal education system in the 2007-2009 period compared with the 2003-2005 period were increased daycare center coverage, lower failure and dropout rates from the first to eighth grades and higher average grades by municipalities on the Prova Brasil. All of these are results that are not related only to better school systems.

“This change in performance is also related to Brazil’s improved economic and social scenario, which means that students don’t have to drop out of school,” said Arretche.

Differences in performance

According to the CEM researchers, one hypothesis for why the inequality in the Brazilian municipal health system is less than that in the educational system lies in the management of the former.

“In the case of the public health system, the federal government has greater capacity to coordinate the municipalities because they present a certain level of services and assistance to the population. But with education, because the networks are municipal and state-run, the capacity for coordination is much less,” said Arretche.

Another factor that affects the performance of education and health policies in Brazilian municipalities is the poverty rate. Although the health system in municipalities where 80% of the population is poor performs similarly to the system in cities where only 20% are poor, in education, cities with more poor people have worse performance.

“The study confirms the results of other studies that pointed to a negative relationship between the poverty rate in the municipality and the performance of its educational system. This relationship stood out consistently with the new methodology,” explained Arretche.

According to the CEM researchers, the results indicated by the study could be tested with general data from the 2010 Census sample, publicized by the IBGE at the end of April, which represent a series of changes in the country between 2000 and 2010 detailed by municipality.